scholarly journals ‘The wairua first brings you together’: Māori experiences of meaningful connection in neurorehabilitation

2021 ◽  
pp. 1-15
Author(s):  
Bobbie-Jo Wilson ◽  
Felicity A. S. Bright ◽  
Christine Cummins ◽  
Hinemoa Elder ◽  
Nicola M. Kayes
Keyword(s):  
Brain Injury ◽  
Focus Groups ◽  
Patient Experience ◽  
Neurological Injury ◽  
Self Reflection ◽  
Culturally Informed ◽  
Kaupapa Māori ◽  
Meaningful Connections ◽  
Design And Methods ◽  
Elemental Layer

Abstract Background and Aims: Therapeutic connections enhance patient experience and outcomes after neurological injury or illness. While we have some understanding of the components necessary to optimise therapeutic connections, these have developed from western-centric ideals. This study sought to explore the perspectives of Māori brain injury survivors, and their whānau (wider family and community), to develop more culturally informed understandings of what matters most for Māori in the development and experience of therapeutic connection. Design and Methods: A bicultural approach underpinned by principles of Kaupapa Māori Research was used. Whānau views and experiences were gathered through wānanga (focus groups). These perspectives were analysed drawing on Māori methods of noho puku (self-reflection), whanaungatanga (relational linkage) and kaitiakitanga (guardianship). Findings: Three wānanga were held with 16 people – 5 brain injury survivors and 11 whānau members. The phrase ‘therapeutic connection’ did not resonate; instead, people spoke of meaningful connections. For rehabilitation encounters to be meaningful, three layers of connection were acknowledged. The elemental layer features wairua (spirit) and hononga (connection) which both underpinned and surrounded interactions. The relational layer reflects the importance of whānau identity and collectivism, of being valued, known, and interactively spoken with. Finally, the experiential layer consists of relational aspects important within the experience: relationships of reciprocity that are mana-enhancing and grounded in trust. These layers are interwoven, and together serve as a framework for meaningful connections. Conclusions: Meaningful connections in neurorehabilitation are underpinned by wairua and hononga; are multi-layered; are enabled through interactions with people, practice, process and place; are inclusive of whānau and resonate with Māori worldviews. The primacy of wairua and whānau within an interconnected view of health, challenges individualistic notions inherent in western health models and deepens existing understandings of meaningful connections in neurorehabilitation which can guide future rehabilitation research, teaching and practice.

scholarly journals Producing a new website for a paediatric liaison mental health team with our service users

2020 ◽  
Vol 9 (4) ◽  
pp. e001128
Author(s):  
Alexander Adams ◽  
Virginia Davies ◽  
Bethany Stubbs
Keyword(s):  
Mental Health ◽  
Focus Groups ◽  
Patient Experience ◽  
Service Users ◽  
Health Issues ◽  
Web Page ◽  
Mental Health Team ◽  
Children And Young People ◽  
Specific Feedback ◽  
Source Of Information

IntroductionOnline resources are an important source of information about mental health issues and services for children and young people. Our service’s website had an out-of-date appearance and was aimed at professionals. More importantly, comments in our routinely collected patient experience data indicated that service users did not know what to expect when coming to our service.MethodsWe followed the model for improvement by testing out changes in plan, do, study and act cycles that included a review of recently updated child and adolescent mental health services’ and youth charities’ websites, designing a new web page for our service and then testing out the website in focus groups. We used routinely collected patient experience data to assess impact on wider patient satisfaction.ResultsFocus groups involving patients, parents and professionals judged the new website to be clearer, more attractive and easier to understand. Routine patient experience data did not reveal any website-specific feedback.ConclusionThis study demonstrates that it is easy and possible to create an attractive and accessible website for a mental health service using quality improvement methodology. In order to capture and integrate ongoing feedback about a service’s website from service users, routinely collected patient experience measures would need to ask specific questions related to this area. In this study, preproject and postproject patient experience data did not generate any specific comments.

scholarly journals 412 - An Affect Education Model for Caregivers: Managing Behavioural and Psychological Symptoms of Dementia

2020 ◽  
Vol 32 (S1) ◽  
pp. 128-128
Author(s):  
Ken Schwartz ◽  
Robert Madan ◽  
Rosalind Sham ◽  
Sandra Gardner
Keyword(s):  
Focus Groups ◽  
Psychological Symptoms ◽  
Care Delivery ◽  
Care Providers ◽  
Term Care ◽  
Self Reflection ◽  
Personal Support ◽  
Behavioural And Psychological Symptoms ◽  
Education Model ◽  
The Impact

Introduction:Providing care for people with behavioural and psychological symptoms of dementia is stressful as these individuals are commonly labelled as aggressive or resistant to care. Few studies have evaluated the impact of providing support to professional caregivers working in long-term care. Our mixed methods pilot study evaluated the impact of the innovative Affect Education Model among health care providers from two Toronto nursing homes.Methods:The two-person centred Affect Educational Model through the use of seven questions that encourage self-reflection teaches that problematic behaviours are co-constructed between individuals with BPSD and caregivers. Study procedures included recruiting nursing staff and personal support workers and teaching them the model in five weekly 30-minute group sessions. Qualitative measures in the form of focus groups were obtained. Quantitative measures were obtained through the use of five questionnaires.Results:Qualitative findings from focus groups identified four themes: facilitators and barriers perceived in current care delivery, the impact of the model experience on staff care delivery, reflections on being taught the model, and future model implementation. Quantitative results were also collected and discussed.Conclusions:The use of both pharmacologic and nonpharmacologic treatment of individuals with BPSD may be greatly enhanced by an interpersonal two-person Affect Education Model that emphasizes the importance of calming down and self-reflection. Future directions include expanding the model to family caregivers through the use of multimedia resources.

Te Waka Oranga: An Indigenous Intervention for Working with Māori Children and Adolescents with Traumatic Brain Injury

2013 ◽  
Vol 14 (3) ◽  
pp. 415-424 ◽  
Author(s):  
Hinemoa Elder
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Extended Family ◽  
Child And Adolescent ◽  
Vital Role ◽  
Cultural Knowledge ◽  
Knowledge Systems ◽  
Leading Role ◽  
Kaupapa Māori

Background: Application of salient cultural knowledge held by families following child and adolescent traumatic brain injury (TBI) has yet to be documented in the literature. While the importance of the family is a well-established determinant of enhanced outcomes in child and adolescent TBI, the emphasis to date has been on the leading role of professional knowledge. The role of whānau (extended family) is recognised as an essential aspect of hauora (wellbeing) for Māori, who are overrepresented in TBI populations. However, whānau knowledge systems as a potent resource for enhancing recovery outcomes have not previously been explored. This paper describes the development of an indigenous intervention, Te Waka Oranga.Method: Rangahau Kaupapa Māori (Māori determined research methods) theory building was used to develop a TBI intervention for working with Māori. The intervention emerged from the findings and analysis of data from 18 wānanga (culturally determined fora) held on rural, remote and urban marae (traditional meeting houses).Results: The intervention framework, called Te Waka Oranga, describes a process akin to teams of paddlers working together to move a waka (canoe, vessel) in a desired direction of recovery. This activity occurs within a Māori defined space, enabling both world views, that of the whānau and the clinical world, to work together. Whānau knowledge therefore has a vital role alongside clinical knowledge in maximising outcomes in mokopuna (infants, children, adolescents and young adults) with TBI.Conclusion: Te Waka Oranga provides for the equal participation of two knowledge systems, that of whānau and of clinical staff in their work in the context of mokopuna TBI. This framework challenges the existing paradigm of the role of families in child and adolescent TBI rehabilitation by highlighting the essential role of cultural knowledge and practices held within culturally determined groups. Further research is needed to test the intervention.

scholarly journals Activation of P2X7 Promotes Cerebral Edema and Neurological Injury after Traumatic Brain Injury in Mice

PLoS ONE ◽  
2012 ◽  
Vol 7 (7) ◽  
pp. e41229 ◽  
Author(s):  
Donald E. Kimbler ◽  
Jessica Shields ◽  
Nathan Yanasak ◽  
John R. Vender ◽  
Krishnan M. Dhandapani
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cerebral Edema ◽  
Neurological Injury

scholarly journals Preoperative mucosal tolerance to brain antigens and a neuroprotective immune response following surgical brain injury

2012 ◽  
Vol 116 (1) ◽  
pp. 246-253 ◽  
Author(s):  
Robert E. Ayer ◽  
Nazanin Jafarian ◽  
Wanqiu Chen ◽  
Richard L. Applegate ◽  
Austin R. T. Colohan ◽  
...  
Keyword(s):  
Brain Injury ◽  
Myelin Basic Protein ◽  
Cerebral Edema ◽  
Transforming Growth Factor ◽  
Basic Protein ◽  
Immunological Tolerance ◽  
Neurological Injury ◽  
Mucosal Tolerance ◽  
Surgical Brain Injury

Object Intracranial surgery causes cortical injury from incisions, hemorrhage, retraction, and electrocautery. The term “surgical brain injury” (SBI) has been developed to categorize this injury inherent to the procedure. Neuroinflammation plays a significant role in SBI. Traditional antiinflammatory therapies are often limited by their immunosuppressive side effects and poor CNS penetration. This study uses mucosal tolerance to develop an immune system that is tolerant to brain myelin basic protein (MBP) so that inflammation can be suppressed in a timely and site-specific manner following surgical disruption of the blood-brain barrier. Methods A standard SBI model using CD57 mice was used. Nasopharyngeal mucosa was exposed to vehicle, ovalbumin, or MBP to develop mucosal tolerance to these antigens. Immunological tolerance to MBP was confirmed in vivo through hypersensitivity testing. Neurological scores, cerebral edema, and interleukin (IL)–1β and transforming growth factor (TGF)–β1 cytokine levels were measured 48 hours postoperatively. Results Hypersensitivity testing confirmed the development of immune tolerance to MBP. Myelin basic protein–tolerant mice demonstrated reduced neurological injury, less cerebral edema, decreased levels of IL-1β, and increased levels of TGFβ1 following SBI. Conclusions Developing preoperative immunological tolerance to brain antigens through mucosal tolerance provides neuroprotection, reduces brain edema, and modulates neuroinflammation following SBI.

scholarly journals Exploring good practice in life story work with people with dementia: The findings of a qualitative study looking at the multiple views of stakeholders

Dementia ◽  
2018 ◽  
Vol 19 (2) ◽  
pp. 182-194 ◽  
Author(s):  
Kate Gridley ◽  
Yvonne Birks ◽  
Gillian Parker
Keyword(s):  
Focus Groups ◽  
Life Story ◽  
Good Practice ◽  
Family Carers ◽  
People With Dementia ◽  
Practice Approach ◽  
Story Work ◽  
The Individual ◽  
Person With Dementia ◽  
Design And Methods

Introduction Despite growing international interest in life story work as a tool for person-centred dementia care, there is little agreement on what constitutes good practice and little evidence from the perspectives of people with dementia or their family carers. Design and methods This paper reports the findings from the qualitative element of a larger study looking at the feasibility of evaluating life story work. Ten focus groups were held with 73 participants: four groups of people with dementia (25 participants); three with family carers (21 participants); and three with staff, professionals and volunteers with experience of life story work (27 participants). Findings: It became apparent through our focus groups that, when people talk about ‘life story work’, different people mean different things. This related to both process and outcomes. In particular, a person with dementia may have very different views from others about what life story work is for and how their life story products should be used. There was general agreement that a good practice approach would be tailored to the individual needs and preferences of the person with dementia. However, in practice many settings used templates and the process was led by staff or completed by family carers. Conclusion We produced nine key features of good practice which could be used to guide the life story work process. Key elements include the recognition that not everyone will want to take part in life story work and that some people may even find it distressing; the importance of being led by the person with dementia themselves; the need for training and support for staff, carers and volunteers; and the potential for life story work to celebrate the person’s life today and look to the future.

Abstract TP269: Lncrna-u90926 Aggravates Ischemic Brain Injury via Promoting Neutrophils Infiltration After Experimental Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jian Chen ◽  
Yun Xu
Keyword(s):  
Ischemic Stroke ◽  
Brain Injury ◽  
Expression Level ◽  
Neurological Deficits ◽  
Neurological Injury ◽  
Experimental Stroke ◽  
Ischemic Brain Injury ◽  
Triphenyltetrazolium Chloride ◽  
Ischemic Brain ◽  
Severity Scores

Background: Long non-coding RNAs (LncRNAs) are expressed at high levels in the brain in a variety of neuropathologic conditions, including stroke. However, the potential role of LncRNAs in ischemic stroke-associated microglial biological function and neurological injury remains largely unknown. Methods: Oxygen-glucose deprivation and transient middle cerebral artery occlusion (MCAO) in C57BL/6 mice were used as in vitro and in vivo ischemic stroke models. Microarray analysis was performed to explore the overall expression level changes of LncRNAs. Real-time polymerase chain reaction (RT-qPCR) was used to detect expression level of LncU90926 in brain, plasma and microglia. ShRNA-LncU90926 in lentivirus and microglia specific Adeno-associated virus (AAV) were used to knockdown LncU90926 in vitro and in vivo separately. Infarct volumes and neurological impairments were assessed by 2,3,5-triphenyltetrazolium chloride (TTC) staining, Neurological Severity Scores (NSS), rotarod test and grip strength respectively. Immunofluorescence staining and flow cytometry were performed to detect the number of neutrophils recruited to brain. RT-qPCR was used to detect the level of chemokines (CXCL, CCL2) and inflammatory mediators associated with neutrophils (MPO, MMP3 and TIMP1). Results: (1). LncU90926 was markedly up-regulated in the infarcted brain and plasma after MCAO. Both MCAO and OGD treatment induced remarkable up-regulation of LncU90926 in microglia. (2). LncU90926 knockdown definitely attenuated brain infarct size and neurological deficits after ischemic stroke. (3). LncU90926 knockdown in microglia reduced the number of neutrophils recruited to brain, and CXCL1 and CCL2 were down-regulated in both MCAO and OGD models. LncU90926 knockdown also induced reduction of MPO, MMP3 and TIMP1 in the infarcted brain. Conclusions: LncU90926 was up-regulated in microglia after experimental stroke, and aggravates ischemic brain injury through facilitating neutrophils infiltration via up-regulating microglial chemokine.

scholarly journals Prehospital management of traumatic brain injury

2008 ◽  
Vol 25 (4) ◽  
pp. E5 ◽  
Author(s):  
Shirley I. Stiver ◽  
Geoffrey T. Manley
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Prehospital Care ◽  
Major Determinant ◽  
Neurological Injury ◽  
Raised Intracranial Pressure ◽  
Long Term Outcome ◽  
Cerebral Herniation ◽  
Prehospital Management

The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.

scholarly journals HMGB1 a-Box Reverses Brain Edema and Deterioration of Neurological Function in a Traumatic Brain Injury Mouse Model

2018 ◽  
Vol 46 (6) ◽  
pp. 2532-2542 ◽  
Author(s):  
Lijun Yang ◽  
Feng Wang ◽  
Liang Yang ◽  
Yunchao Yuan ◽  
Yan Chen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Edema ◽  
Therapeutic Potential ◽  
High Mobility ◽  
Neurological Injury ◽  
Secondary Brain Injury ◽  
Cell Degeneration ◽  
Injured Brain ◽  
Walking Tests

Background/Aims: Traumatic brain injury (TBI) is a complex neurological injury in young adults lacking effective treatment. Emerging evidences suggest that inflammation contributes to the secondary brain injury following TBI, including breakdown of the blood brain barrier (BBB), subsequent edema and neurological deterioration. High mobility group box-1 (HMGB1) has been identified as a key cytokine in the inflammation reaction following TBI. Here, we investigated the therapeutic efficacy of HMGB1 A-box fragment, an antagonist competing with full-length HMGB1 for receptor binding, against TBI. Methods: TBI was induced by controlled cortical impact (CCI) in adult male mice. HMGB1 A-box fragment was given intravenously at 2 mg/kg/day for 3 days after CCI. HMGB1 A-box-treated CCI mice were compared with saline-treated CCI mice and sham mice in terms of BBB disruption evaluated by Evan’s blue extravasation, brain edema by brain water content, cell death by propidium iodide staining, inflammation by Western blot and ELISA assay for cytokine productions, as well as neurological functions by the modified Neurological Severity Score, wire grip and beam walking tests. Results: HMGB1 A-box reversed brain damages in the mice following TBI. It significantly reduced brain edema by protecting integrity of the BBB, ameliorated cell degeneration, and decreased expression of pro-inflammatory cytokines released in injured brain after TBI. These cellular and molecular effects were accompanied by improved behavioral performance in TBI mice. Notably, HMGB1 A-box blocked IL-1β-induced HMGB1 release, and preferentially attenuated TLR4, Myd88 and P65 in astrocyte cultures. Conclusion: Our data suggest that HMGB1 is involved in CCI-induced TBI, which can be inhibited by HMGB1 A-box fragment. Therefore, HMGB1 A-box fragment may have therapeutic potential for the secondary brain damages in TBI.

Multimodality Monitoring in Neurocritical Care: Decision-Making Utilizing Direct And Indirect Surrogate Markers

2018 ◽  
Vol 34 (6) ◽  
pp. 449-463 ◽  
Author(s):  
Fawaz Al-Mufti ◽  
Megan Lander ◽  
Brendan Smith ◽  
Nicholas A. Morris ◽  
Rolla Nuoman ◽  
...  
Keyword(s):  
Brain Injury ◽  
Neurocritical Care ◽  
Delayed Cerebral Ischemia ◽  
Neurological Injury ◽  
Innovative Technology ◽  
Secondary Brain Injury ◽  
Neurologic Injury ◽  
Irreversible Damage ◽  
Traumatic Intracranial Hemorrhage ◽  
Substantial Progress

Substantial progress has been made to create innovative technology that can monitor the different physiological characteristics that precede the onset of secondary brain injury, with the ultimate goal of intervening prior to the onset of irreversible neurological damage. One of the goals of neurocritical care is to recognize and preemptively manage secondary neurological injury by analyzing physiologic markers of ischemia and brain injury prior to the development of irreversible damage. This is helpful in a multitude of neurological conditions, whereby secondary neurological injury could present including but not limited to traumatic intracranial hemorrhage and, specifically, subarachnoid hemorrhage, which has the potential of progressing to delayed cerebral ischemia and monitoring postneurosurgical interventions. In this study, we examine the utilization of direct and indirect surrogate physiologic markers of ongoing neurologic injury, including intracranial pressure, cerebral blood flow, and brain metabolism.

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